1
|
Nagoya S, Okazaki S, Tateda K, Kosukegawa I, Kanaizumi A, Yamashita T. Successful reimplantation surgery after extraction of well-fixed cementless stems by femoral longitudinal split procedure. Arthroplast Today 2020; 6:123-128. [PMID: 32211488 PMCID: PMC7083742 DOI: 10.1016/j.artd.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/19/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background Well-fixed cementless stems sometimes need to be extracted in patients with complications including periprosthetic infection, stem-neck breakage, or trunnionosis. The purpose of this study was to report the clinical outcome in patients undergoing reimplantation surgery after removal of a well-fixed porous-coated cementless stem by the femoral longitudinal split (FLS) procedure. Methods We conducted a retrospective study and radiographic review of 16 patients who had undergone reimplantation following the FLS procedure to remove a well-fixed stem due to periprosthetic infection, stem-neck breakage, or trunnionosis. The study group consisted of 2 men and 14 women with an average age of 68.4 years. Mean follow-up was 44.6 months. The Kaplan-Meier method was used to evaluate the longevity of the stem. Results The average operation time was 272 ± 63 minutes and intraoperative bleeding was 420 ± 170 mL. Although postoperative dislocation occurred in 5 hips and subsidence of the stem was found in 2 hips after surgery, no progressive subsidence was observed and the clinical JOA and JHEQ scores were both improved after reimplantation surgery. Reimplantation surgery with Zweymüller-type stems revealed evidence of osseointegration of the stem without femoral fracture. Kaplan-Meier survival analysis of stem revision for any reason as the end point revealed 70.0% survival at 9 years. Conclusions In this study, we experienced some complications in patients with trunnionosis or periprosthetic infections. However, the FLS procedure is expected to confer successful clinical results without loosening of the reimplanted cementless stem, after safe extraction of well-fixed porous-coated cementless stems without fracture.
Collapse
Affiliation(s)
- Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Shunichiro Okazaki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Arata Kanaizumi
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| |
Collapse
|
2
|
Uchiyama K, Moriya M, Fukushima K, Yamamoto T, Takahira N, Takaso M. Clinical Results and Prognostic Factors for Outcomes of Valgus Femoral Osteotomy Combined with Chiari Pelvic Osteotomy for Osteoarthritis of the Hip. JB JS Open Access 2017; 2:e0006. [PMID: 30229213 PMCID: PMC6132470 DOI: 10.2106/jbjs.oa.16.00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Surgeons have long debated whether advanced or end-stage osteoarthritis of the hip in young patients should be treated with total hip arthroplasty or osteotomy. We reviewed the intermediate-term clinical results of valgus femoral osteotomy combined with Chiari pelvic osteotomy (VCO) for advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip in young patients and analyzed prognostic factors related to conversion to total hip arthroplasty. Methods The study group included 54 hips in 50 patients (5 men and 45 women; average age at the time of surgery, 45.6 years). The minimum and average durations of follow-up were 10 and 17.6 years, respectively. The Japanese Orthopaedic Association hip score (JOA score) was used for clinical evaluation. The probability of survival of the VCO from the time of the operation until the end point of conversion to total hip arthroplasty was calculated with use of the Kaplan-Meier method. We defined prognostic factors of outcome (conversion to total hip arthroplasty) with the Cox proportional hazards model. Results The mean total JOA score increased from 53.0 points preoperatively to 77.1 points at 1 year postoperatively, 81.6 points at 5 years, and 76.8 points at 10 years. The survival rates were 83.3%, 59.7%, and 46.9% at 10, 15, and 20 years, respectively. On univariate and multivariate analyses, patients with a low degree of acetabular roof obliquity had better postoperative results. Conclusions VCO is a surgical approach that preserves joint function in young patients with advanced or end-stage osteoarthritis associated with severe acetabular dysplasia of the hip. The postoperative prognosis of VCO was improved in patients with a low degree of acetabular roof obliquity. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| | - Mitsutoshi Moriya
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| | - Takeaki Yamamoto
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine (K.U., M.M., K.F., T.Y., and M.T.) and School of Allied Health Sciences (N.T.), Kitasato University, Kanagawa, Japan
| |
Collapse
|
3
|
Abstract
INTRODUCTION Conversion to total hip arthroplasty (THA) from a fused hip is a challenging procedure because of the technical difficulties involved. Here we report the surgical procedure and the early clinical outcome of conversion THA from a fused hip through a direct anterior approach. METHODS 9 consecutive THAs following hip fusion were performed in 9 patients. Of these, 6 patients had undergone surgical hip fusion and 3 patients had nonsurgical fusion. RESULTS The mean time interval between fusion and THA was 29.7 years. The mean follow-up period was 5.2 years. All THAs were performed using a direct anterior approach on a standard surgical table. The mean operative time was 68.7 minutes. The mean intraoperative blood loss was 377 g. All acetabular components were placed within Lewinnek's safe zone. The mean Japanese Orthopaedic Hip Score significantly improved from 54.0 to 73.2. One early anterior dislocation occurred and was treated conservatively. No revision surgery was required. CONCLUSIONS The direct anterior approach allows for an accurate and less invasive implantation of the total hip components.
Collapse
|
4
|
Tamaki T, Oinuma K, Miura Y, Shiratsuchi H. Total Hip Arthroplasty after Previous Acetabular Osteotomy: Comparison of Three Types of Acetabular Osteotomy. J Arthroplasty 2016; 31:172-5. [PMID: 26264177 DOI: 10.1016/j.arth.2015.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 07/13/2015] [Indexed: 02/01/2023] Open
Abstract
To compare surgical results of total hip arthroplasty (THA) following acetabular osteotomy, operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following rotational periacetabular osteotomy (RAO; RAO group), 16 hips following shelf acetabuloplasty (Shelf group), and 2475 hips without previous osteotomy (Control group) were retrospectively reviewed. The operative time was significantly longer in the RAO group than in the Control group. Bulk bone augmentation was required more often in the Chiari and RAO groups than in the Control group. An early migration of the acetabular cup occurred in 2 hips in the RAO group. RAO made conversion to THA more complicated than did the Chiari osteotomy or the shelf acetabuloplasty.
Collapse
Affiliation(s)
- Tatsuya Tamaki
- Funabashi Orthopedic Hospital, Joint Reconstruction Center, Funabashi, Chiba 274-0822 Japan
| | - Kazuhiro Oinuma
- Funabashi Orthopedic Hospital, Joint Reconstruction Center, Funabashi, Chiba 274-0822 Japan
| | - Yoko Miura
- Funabashi Orthopedic Hospital, Joint Reconstruction Center, Funabashi, Chiba 274-0822 Japan
| | - Hideaki Shiratsuchi
- Funabashi Orthopedic Hospital, Joint Reconstruction Center, Funabashi, Chiba 274-0822 Japan
| |
Collapse
|
5
|
Tamaki T, Oinuma K, Shiratsuchi H, Akita K, Iida S. Hip dysfunction-related urinary incontinence: a prospective analysis of 189 female patients undergoing total hip arthroplasty. Int J Urol 2014; 21:729-31. [PMID: 24593237 DOI: 10.1111/iju.12404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Abstract
Patients reporting that their symptoms of urinary incontinence have decreased after total hip arthroplasty can be encountered in orthopedic practice. In this questionnaire-based study, we prospectively evaluated the symptoms of urinary incontinence before and after total hip arthroplasty. The International Consultation on Incontinence Questionnaire-Short Form was used to prospectively evaluate these symptoms in 189 consecutive female patients undergoing total hip arthroplasty. The patients were asked to fill in a questionnaire before and 3 months after surgery. A decrease in the International Consultation on Incontinence Questionnaire-Short Form score of ≥1 point was defined as an improvement, whereas an increase of ≥1 point was defined as worsening. A total of 81 (43%) patients reported urinary incontinence before total hip arthroplasty. At 3 months after surgery, symptoms of urinary incontinence were improved in 64% of these patients, remained unchanged in 32% and worsened in 4%. Mean International Consultation on Incontinence Questionnaire-Short Form score in patients with urinary incontinence before surgery significantly improved from 6.0 to 3.5 (P = 0.0002). These findings suggest a relationship between hip joint function and pelvic floor function, and consequently a hip dysfunction-related urinary incontinence.
Collapse
Affiliation(s)
- Tatsuya Tamaki
- Joint Replacement Center, Funabashi Orthopedic Hospital, Funabashi, Chiba; Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, Tokyo
| | | | | | | | | |
Collapse
|
6
|
Ten year results of transtrochanteric valgus osteotomy with or without the shelf procedure. INTERNATIONAL ORTHOPAEDICS 2013; 37:599-604. [PMID: 23385609 DOI: 10.1007/s00264-013-1810-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to examine retrospectively the effectiveness of Sugioka's transtrochanteric valgus osteotomy (TVO) combined with the shelf procedure for patients who had advanced osteoarthritis (OA) of the hip with severe acetabular dysplasia. METHODS Sixty-two hips in 61 patients were reviewed retrospectively between April 1993 and March 2009. Of these hips, 25 hips with the pre-operative acetabular head index (AHI) ≥ 60 % (single group) underwent a TVO, whereas the other 37 with AHI < 60 % (combined group) underwent a TVO combined with the shelf procedure. RESULTS Using conversion to total hip arthroplasty as the endpoint, the Kaplan-Meier survival rates at ten years were calculated to be 85.5 % for the single group and 100 % for the combined group; there was a significant difference between the two groups (p < 0.05, log-rank test). Similarly, calculated using progressive OA as the endpoint, survival rates at ten years were 69.5 % and 89.3 % respectively; there was also a significant difference between the two groups (p < 0.05, log-rank test). In the single group, the latest radiographic evaluations of the patients with the pre-operative AHI ≥ 70 % were significantly better than those of the patients with the pre-operative AHI < 70 % (P < 0.05). CONCLUSION More satisfactory ten year results of TVO were obtained in cases that had a pre-operative AHI of ≥70 %, or where the shelf procedure was added. It is desirable that acetabuloplasty be added for patients with pre-operative AHI < 70 %.
Collapse
|
7
|
Results and prognostic factors of valgus osteotomy in middle-aged patients with advanced or terminal osteoarthritis of the hip. J Orthop Sci 2010; 15:20-9. [PMID: 20151247 DOI: 10.1007/s00776-009-1415-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/22/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND From 1979 to 2005, a total of 279 hips in 249 patients with advanced and/or terminal-stage osteoarthritis of the hip underwent valgus osteotomy. Among them, we reviewed 256 hips in 229 patients (91.8%) with a minimum follow-up of 1 year. We reviewed the clinical and radiological results and analyzed prognostic factors that may have affected the postoperative outcome. METHODS Clinical evaluation was made according to the Japanese Orthopaedic Association Hip score (JOA score). Radiological evaluation was made according to the criteria of Itoman. The Kaplan-Meier method was used to calculate the probability of survival of valgus osteotomy from the time of the operation until the endpoint of a subsequent operation. To examine prognostic factors, clinical parameters and radiographic measurements were compared between patients in an improved group and an aggravated group. Additionally, clinical parameters and radiographic measurements were used to evaluate the JOA score at the latest follow-up. RESULTS The mean JOA score was 52.6 before the operation; it was 80.6, showing the most marked improvement, 5 years after the operation, gradually decreased thereafter; and it was 65.0 after 20 years. Radiological results were good or fair in 78% even 10 years after the operation. The survival rates were 91%, 63%, and 52%, respectively, at 10, 15, and 20 years after valgus osteotomy. Concerning prognostic factors, the improved group tended to show preoperative good range of motion and unilateral involvement. Concerning the association between prognostic factors and the JOA score at the latest follow-up observation, the JOA score was significantly lower for an acetabular head index (AHI) <60% than for AHI >or=60%. CONCLUSIONS Valgus osteotomy is effective joint-preserving surgery for advanced or terminal-stage osteoarthritis of the hip in middle-aged patients, and it is acceptable for clinical and radiological evaluation. If the AHI is <60%, valgus osteotomy should be combined with Chiari's pelvic osteotomy.
Collapse
|
8
|
Nagoya S, Kaya M, Sasaki M, Tateda K, Kosukegawa I, Yamashita T. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. ACTA ACUST UNITED AC 2009; 91:1142-7. [PMID: 19721037 DOI: 10.1302/0301-620x.91b9.21736] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Total hip replacement for high dislocation of the hip joint remains technically difficult in terms of preparation of the true acetabulum and restoration of leg length. We describe our experience of cementless total hip replacement combined with a subtrochanteric femoral shortening osteotomy in 20 hips with Crowe grade IV dislocation with a mean follow-up of 8.1 years (4 to 11.5). There was one man and 17 women with a mean age of 55 years (44 to 69) at the time of the operation. After placment of the acetabular component at the site of the natural acetabulum, a cementless porous-coated cylindrical femoral component was implanted following a subtrochanteric femoral shortening osteotomy. The mean Japanese Orthopedic Association hip score improved from a mean of 38 (22 to 62) to a mean of 83 points (55 to 98) at the final follow-up. The mean lengthening of the leg was 14.8 mm (−9 to 34) in patients with iliofemoral osteoarthritis and 35.3 mm (15 to 51) in patients with no arthritic changes. No nerve palsy was observed. Total hip replacement combined with subtrochanteric shortening femoral osteotomy in this situation is beneficial in avoiding nerve injury and still permits valuable improvement in inequality of leg length.
Collapse
Affiliation(s)
- S. Nagoya
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| | - M. Kaya
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| | - M. Sasaki
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| | - K. Tateda
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| | - I. Kosukegawa
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| | - T. Yamashita
- Department of Orthopaedic Surgery Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, Japan
| |
Collapse
|
9
|
[Indications and results of corrective pelvic osteotomies in developmental dysplasia of the hip]. DER ORTHOPADE 2008; 37:556-70, 572-4, 576. [PMID: 18493740 DOI: 10.1007/s00132-008-1240-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Joint-preserving reconstructive surgeries in children and adolescents remain challenging for orthopaedists with regard to indication and surgical technique. Besides skeletal maturity and tissue quality at the time of surgery, the kind and degree of deformity, the causative pathologies in secondary dysplasias, and the prognosis have to be considered when deciding for or against a surgical procedure. Developmental dysplasia of the hip (DDH) is the most frequent deformity that indicates reorienting surgery on the hip joint in children and adolescents. The aim of these procedures is to prevent early secondary osteoarthritis. For patients and families as well as for the orthopaedist, risk-benefit analysis is of major interest. METHODS In this study, the surgical techniques and specialties of different reconstructive operations are presented. Based on a review of the literature, the results of defined surgical methods are discussed and compared with own experiences. RESULTS Only limited information is available about the clinical long-term outcome after defined reconstructing surgery on the hip joint in children and adolescents. The degree of the deformity, the age of onset, and the surgical experience of the orthopaedist are crucial factors in decision making for or against a surgical treatment. In early childhood, acetabuloplasty and Salter osteotomy are widely accepted to correct DDH. Triple and periacetabular osteotomies are preferred and have shown promising results in late adolescence and young adults. When the triradiate cartilage (growth plate) is closed, good outcomes can be achieved by the Ganz osteotomy. Intertrochanteric varus and derotation osteotomies of the femur may serve as additional procedures for pelvic osteotomies and are rarely indicated as a single procedure today. CONCLUSION Reconstructive surgery on the hip joint improves function and may prevent early osteoarthritis and delay progression of cartilage degeneration in most patients when the indication and surgical technique are appropriate.
Collapse
|
10
|
Koyama Y, Miyashita M, Irie S, Takatori Y, Yamamoto M, Karita T, Kazuma K. A study of the reality of daily life among patients with osteoarthritis of the hip undergoing conservative treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.joon.2007.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
11
|
Haverkamp D, Eijer H, Besselaar PP, Marti RK. Awareness and use of intertrochanteric osteotomies in current clinical practice. An international survey. INTERNATIONAL ORTHOPAEDICS 2007; 32:19-25. [PMID: 17431624 PMCID: PMC2219926 DOI: 10.1007/s00264-006-0270-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 08/22/2006] [Accepted: 08/24/2006] [Indexed: 11/26/2022]
Abstract
Current literature shows that intertrochanteric osteotomies can produce excellent results in selected hip disorders in specific groups of patients. However, it appears that this surgical option is considered an historical one that has no role to play in modern practice. In order to examine current awareness of and views on intertrochanteric osteotomies among international hip surgeons, an online survey was carried out. The survey consisted of a set of questions regarding current clinical practice and awareness of osteotomies. The second part of the survey consisted of five clinical cases and sought to elicit views on preoperative radiological investigations and preferred (surgical) treatments. The results of our survey showed that most of these experts believe that intertrochanteric osteotomies should still be performed in selected cases. Only 56% perform intertrochanteric osteotomies themselves and of those, only 11% perform more than five per year. The responses to the cases show that about 30–40% recommend intertrochanteric osteotomies in young symptomatic patients. This survey shows that the role of intertrochanteric osteotomies is declining in clinical practice.
Collapse
Affiliation(s)
- D Haverkamp
- Academic Medical Centre, Orthotrauma Research Centre Amsterdam (G4-No), Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
12
|
Nozawa M, Enomoto F, Shitoto K, Matsuda K, Maezawa K, Kurosawa H. Rotational acetabular osteotomy for osteonecrosis with collapse of the femoral head in young patients. J Bone Joint Surg Am 2005; 87:514-20. [PMID: 15741616 DOI: 10.2106/jbjs.c.01461] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While rotational acetabular osteotomy has been reported to be successful for the treatment of osteoarthritis of the dysplastic hip, little is known about its efficacy in the treatment of osteonecrosis of the femoral head. METHODS We retrospectively reviewed the results for a consecutive series of twenty-one patients (twenty-five hips) who had undergone rotational acetabular osteotomy between 1995 and 2001 for the treatment of extensive osteonecrosis of the femoral head associated with collapse. All but two of the patients had a history of steroid therapy as part of a treatment regimen for various diseases. At the time of surgery, the mean age of the five men and sixteen women was 29.0 years. The mean duration of follow-up was forty-nine months. No patient was lost to follow-up. The lesions were classified according to the staging system described by Steinberg et al., and the extent of necrosis was measured with use of the criteria described by Kerboul et al. Clinical evaluation was performed with use of the scoring system of Merle d'Aubigne and Postel. Radiographic evaluation was performed with use of yearly serial anteroposterior and lateral plain radiographs. RESULTS The mean Merle d'Aubigne and Postel score improved from 11.3 points preoperatively to 14.9 points at the time of the final follow-up (p < 0.001). The mean pain score improved from 3.0 to 5.6 points (p < 0.001). However, the mean mobility score was 5.3 points preoperatively but only 4.9 points postoperatively (p = 0.1). All of the osteotomy sites showed radiographic evidence of osseous union at the time of the latest follow-up. Collapse of the femoral head progressed in seven hips, but in six of these hips the change in the extent of collapse was <2 mm. CONCLUSIONS In the present study of young patients with extensive osteonecrosis and collapse of the femoral head, rotational acetabular osteotomy was associated with symptomatic relief and absence of substantial collapse of the femoral head at the time of early to intermediate-term follow-up.
Collapse
Affiliation(s)
- Masahiko Nozawa
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | | | | | | | | | | |
Collapse
|
13
|
Haverkamp D, Marti RK. Intertrochanteric osteotomy combined with acetabular shelfplasty in young patients with severe deformity of the femoral head and secondary osteoarthritis. ACTA ACUST UNITED AC 2005. [DOI: 10.1302/0301-620x.87b1.15117] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intertrochanteric osteotomy may postpone the need for total hip replacement (THR). In young patients with an acquired deformity of the femoral head and secondary osteoarthritis, a valgus intertrochanteric osteotomy may allow better congruency but the acetabular cover may become insufficient because of subluxation of the femoral head. In patients with a spherical femoral head and acetabular dysplasia, cover can still remain insufficient after varus displacement osteotomy. We present the long-term results of intertrochanteric osteotomy combined with an acetabular shelfplasty in both these circumstances. Sixteen hips (15 patients) with a deformed femoral head, and ten (seven patients) with a spherical femoral head, underwent an intertrochanteric osteotomy and acetabular shelfplasty. The mean age at the time of surgery was 30 and 37 years and the mean final follow-up was 15 and 19 years, respectively. Six patients in the deformed group, but only one in the spherical group, had required a THR by the time of their final follow-up. In both groups, those who had not undergone a THR had a good result. Acetabular shelfplasty is an excellent addition to an intertrochanteric osteotomy and gives full cover of the femoral head in patients with a deformity of the head and secondary osteoarthritis.
Collapse
Affiliation(s)
- D. Haverkamp
- Department of Orthopaedic, Surgery, Meibergdreef 15, 1105 A2 Amsterdam, The Netherlands
| | - R. K. Marti
- Department of Orthopaedic, Surgery, Meibergdreef 15, 1105 A2 Amsterdam, The Netherlands
| |
Collapse
|